Billing Compliance

I am about to become an employee of a group whose culture is to do “routine annual physicals” (RAP). I had mostly stopped doing physicals for patients with Medicare since physicals are usually not covered (unless by a secondary insurance or Medicare advantage plan).The group I will join usually bills Medicare for RAPs, using the 99215 code, plus an additional charge for (I think) 99397 or some other “preventive” code. Are other practices still using 99215 with Medicare patients? Have there been actions from the OIG to recover overpayments related to the use of 99215 for physicals? Can you offer suggestions that would help me get this clarified? It seems, for example, that an internal audit by someone familiar with Medicare rules would help either reassure me or make it clear that the group is not in compliance with Medicare rules.

Do I need a separate insurance policy for protection in case a HIPAA violation lawsuit is ever filed against me? It doesn’t seem like medical malpractice would cover this.

Appeal letter for prompt payment from your medical practice payers.

Here is a sample collections letter to use at your medical practice.

Collections Letter 3

Collections Letter 3 -- Spanish

Collections Letter 2 -- Spanish

Appeal Letter Justifying Emergency Treatment

Collections Letter 1 -- Spanish

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Assignment of Benefits -- Spanish

Use this letter when a claim is denied because a patient saw a physician in your group who is not his or her designated primary care physician.

This Advance Beneficiary Notice form, created by CMS, is best managed by the clinical team at your medical practice versus the front office staff.

Download this sample form to use with your medical practice's business associates to ensure private patient data protection and meet HIPAA regulations.

Technology offers so many different tools to accomplish so many different tasks.

If you’ve been putting off developing a compliance procedure for the new Red Flags Rule aimed at preventing identity theft, the time has come to act.

Following a two-year demonstration project in four states, Medicare’s Recovery Audit Contractor (RAC) program is going nationwide in 2009.

This month: Office vs. hospital outpatients; 2009 surgical global package; When to code a consult.

Whether a staff departure is amicable or not, it’s vital to formalize and document a process for removing an exiting employee’s IT access.

Outsourcing billing operations can be a relief to a frazzled practice. But you need to do it right; after all, your practice’s revenue is at stake.

Negative Nellie, Bitter Betty… Sound familiar? Here’s our advice on spotting a spoiler.